Sunday, 12 August 2018

After nearly a decade in Academics and the struggle to standardize Emergency Medicine Post
Graduate Training in India I have come to realize that the only way Residents
in MD/DNB can succeed is Standardize Themselves to a Discipline which will
build their knowledge and skills.

I am laying out a
Plan which the residents can follow to help them achieve their
goals.

Studying Hard is key
and following the plan is vital.

It is similar to a weight loss plan and I call
it Ignorance Loss Plan in EM…

Ground Rules:

Residents have a 1000
days to learn, commit mistakes and correct them.

Using every day , every
moment is key.

Residents don’t need a Degree
to Learn and should not think that they can learn after MD/DNB because that
takes away few years from the life of performance.

PGY 1:

Finish ATLS ACLS PALS
AUTLS within the first three months of starting. It’s crucial because having Resuscitation
mastered is key to building on knowledge.

Go on to read FOAMED
and data on websites because by this time you have read the book twice and seen
tons of cases to be able to master to the subject.

Start Preparing for
Exams

Complete the Thesis.

Attending The National
Emergency Medicine Board Review of India Course. NEMBRIC held at National Board
of Examinations / New Delhi every year.

Attend the EXAMATHALON
which is held in Kerala every year in First half of the year which helps you
using Mock Examination patterns for training.

Disclaimer: Many Residents are forced to attend Conferences. Remember You don't go to a conference to gain Resident Level Knowledge...That's done in your PG Training.

Be smart and Know who is speaking on the stage ... Realize whether that person who claims to be an Expert Specialist is really qualified to speak...Time is crucial don't waste it and gain knowledge from someone who is not qualified.

I want you all to realize that I want you all to succeed. I am a hard core academician and respect and worship The Goddess of Knowledge. I believe that this is the knowledge which brings food to my table and this is the knowledge which gives power to practice patient care.

I take this education seriously and plead that you do so too.

Remember the fact that Emergency Medicine in India is One HOD Model and not like the west where many consultants work. This job market has shrunken with fake Degree Manufacturing process set up.

The Consultants from other department will respect you when you have the knowledge and participate in discussions as an equal.

They have to respect you not as a CMO but as a Specialist.

We will have to work hard on creating jobs, meanwhile you the NEET Selected MCI Recognized MD/NBE Legitimate Residents have to work hard to accomplish the goals.

Passing Exams is just one step , having the knowledge and skills is step two and become a good specialist is the last never ending step.

Thursday, 2 November 2017

I have been watching the changing healthcare scenario across the world. The way things are done, the physicians behavior the practice models, the business pathways are all in dynamic change. India is not immune to this change and in fact an important part of it.

I want to focus on an important issue in this change. That is the rise of Conferences, Meetings and Workshops across India.

An Academic meeting is an event where interested come to learn, experts come to discuss ideas, Chalk roadmaps and conceive innovations. The meeting holds a value which is applicable to all who are a part of the event.

I googled Medical Conferences in India and was aghast to see the number of Conferences.

What I observe is the sudden surge in number of conferences across India. I see very little content and a lot of hype. I always write after I have spoken to a satisfactory number of stakeholders.

I have come to realize that be it any specialty, the number of conferences and societies has gone up significantly. What has not gone up is innovation and systems development to better the healthcare.

I have realized that may physicians have this misconstrued idea that Conference is an Easy way to fame and it is a Marketing tool.

The mushrooming corporate hospitals feel that Conference is the easiest way to connect with physicians and media so that there can be a Hype under the name of CME.

Young Physicians feel that by being speaker at the Conference they are authorities.

If you research closely, it is like a Mafia where only a couple of people roam around taking pictures, and cross invite each other to their own little kitchen cabinet events.

Every Young Physician wants to become a “BOSS” as soon as possible. Gather a few people and establish a Society/Association. Then go to the Pharma and arm twist funds and then start doing series of Conferences.

With the rising number of Non Accredited Certificate Holding Medical Doctors in the Indian Health Sector and growing demand to aspire to show their For Profit Hospital Employers that they are Important, CONFERENCE is an easy gateway.

Another gig which I have noticed is the Business of Awards. This is like the new mantra for self-recognition.

Awards are created after a lot of thought and have greater implications. I nowadays see 35 year old Physicians getting titles like Knighthood and Life Time Achievement Awards. If one is a keen observer this is very comical and amusing.

Twitter Handle/ Facebook/Instagram is now the new fame pathway. It is very easy to track the photo-fame phenomenon which is gripping the aspiring leaders.

In all this one thing lags behind and that is innovation to better patient care. The same lectures cut and paste from textbooks, teaching of wrong data which have no scientific bearing or backing is what starts the process of wrong practices.

Speakers are created after years of experience and mentoring. They speak on topics with in depth knowledge with a commitment to teach right things and chart right pathways. Conferences engage such speakers and that’s what makes the Conference a valuable one. That is why across the world conferences have a value.

India is the largest economy of the world. We can be a huge part of the science of evolving medicine. Commitment to evolution of innovation is the gateway to better patient care.

It is with this mission that INDUSEM was founded in 2005. Today 11 years later it stands as the only innovative non association, non-colonial, nonpolitical academic model which focusses on patient centered research, education and care.

This new phenomenon which is infecting young upcoming physicians who are getting leadership positions in the mushrooming private hospital industry in India, where they think that Conference is what imprints them as an expert and the self-patting award system is what recognizes them as RENOWNED EXPERTS is a damaging happening in Developing India.

When I was a Post graduate student, attending a national conference CME was like the epitome of updating knowledge.

Today the above gateway is lost, thanks to the large number of conferences and the mafia where few have made it their business to loot the pharma systematically and mislead young students and residents.

I always state…”Innovators are found in PubMed and rest all are in the Pubs”. The real identity of an expert can be checked in PubMed which displays the dedication of an innovator in medicine.

Identity Crisis is a bad disease….. Fame will come when it has to come. When all is said and done, content is what is important, Solution is not Conferences and Solicited Award circuiting.

This can be regulated by one’s own conscience and self-realization…… until then the self-misled will lead and those who can be misled will be misled…..

Thursday, 2 February 2017

There is a lot of media discussion
about the death of a Road Traffic Trauma Victim on the road without being
helped by bystanders in Karnataka.

Additionally exactly a week ago this very media was abuzz covering the story of an Anesthetist who gave CPR to a patient at Mumbai airport and saved a life.

A Tale of two Cities, Same Scenarios where a patient needed help and two different actions.

One saved the life one did not.

This left me thinking about the challenges for bystanders
to act as good Samaritans.

About the Road Traffic Incident:

With all International brands of cars on
the modern Indian roads and the affordability quotient of masses on the high …
car speed has become the major factor on buying car.

Unlike the other world…where car safety
is criteria for car buying… in India design and speed are the major factors for
car sales in India.

There are 4 lanes to 6 lanes highways,
there are international branded cars and there are our Indian drivers who have
the least disregard for other drivers or pedestrians. Coupled with that is the gross APATHY of the masses to just not respond to trauma victims lying
on the roads.

I was traveling in India recently and
in a city I saw a crash happen in front of my eyes. A driver was driving his
imported car and it crashed into a motor cycle being driven by a Non Helmeted
rider. It was an accident because the motor cycle skid and came in front of the
car and the rider got head injury. The rider was awake and bleeding but what
happened next ?

People gathered and started beating up
the driver who had stopped, gotten out of the car and picked the rider and put
him in his car and was taking him to the hospital. The first response of the by
standers was the Driver in Car must have made the mistake …… Hammer the driver.

No one cared about the VICTIM ?

This is a wrong behavior which needs to
be changed. The thought that Car Drivers have more money so they can afford
cars and if they are in a crash it’s their fault so take justice into their
hands and forget the patient is absolutely wrong. Forgetting the patient is just wrong.

This leads to the phenomenon of drivers
running away after hitting other pedestrians / vehicles. If anyone wants to
take the crash victims to the hospital they will not and just run away because
they don’t want to face the mob mentality.

And the mob does nothing except to
stare in majority of the cases. There are many cases when mobs do act….Well
they should act always.

In many of my public events where I was
called to inaugurate Road Safety and Basic Emergency Care Training programs I
ask one question: What do you do when you see a crash on the road?

The truthful answer I get is: we don’t
stop because we don’t want to get involved with the Mob or the Police.

Why are we as citizens afraid of doing
the right thing?

Police will not bother you if you
helped a bleeding victim. There is no use of learning Basic Life support
courses if you don’t have the intent to help someone in need. We still are far
from having EMS within minutes so the cars and bystanders are the first
responders and hence going to a hospital which has 24/7 Emergency Care with
Radiology and Laboratory Back up is the first important step after stabilizing
the airway c spine and stopping the bleeding.

Focusing on the Injured is very
important and that’s a First.

We have crowded cities and vast rural
corridors.

We have lack of space for pedestrians
to walk that’s why they walk on roads.

We have high speed corridors going
through rural area without crossings, overhead bridges or barricades.

This is all there because development
and infrastructure are in a mismatch.

What we can match is our behavior.

The government has constituted the good
Samaritan act. Even though this has happened the myth that helping a trauma
victim will invite undue involvement with the law continues to haunt the Indian
bystander.

There are innumerable factors which are
related to driving behaviors, road designs and traffic cultures. There are a multitude
of factors related to legal crackdown upon road killers and the various
agencies trying to institute safer roads and discipline violating drivers.

That is not in question here.

The question is “How do we change the
GROSS INDIFFERENCE OF THE MASSES”

About the Mumbai CPR Saving Incident:

The CPR was provided by a trained anesthetist.

The media was abuzz.

The lesson learnt should have been

CPR Training at every level is a must. That is what media should have advocated.

AED across the nation is what should have been advocated.

Bystander RESCUE is crucial to saving lives for individual patients and in disasters.

SUGGESTED INTERVENTIONS:

EDUCATION, AWARENESS, ADVOCACY, SOCIAL MARKETING, PROMOTION

ENGAGING THE GOVERNMENT, THE AGENCIES,
THE NON GOVERNMENTAL ORGANIZATIONS

TEACHING AT SCHOOL, COLLEGE, INDUSTRY
LEVEL, USING RADIO, TV TO PROMOTE THE MESSAGE.

The vehicle industry and the road
traffic license departments have to take a lead role in education and
regulation of behavior of travelers. Just selling vehicles and issuing licenses
is not the only responsibility.

Changing our behavior and educating the
masses is the key.

We should be responsible and
always remember the INJURED IS ALWAYS FIRST !